Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; a licensed producer in all states (TX 13695); (AR Ins. Lic.100106022); in CA & MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY , AIS Affinity Insurance Agency.
CA Insurance License # 0795465 and #0G94493
FATCA Notice: Please go to
Aon.com/FATCA to obtain the appropriate W-9.